The Resurgent Lassa fever Epidemic and What You Ought to Know

February 4, 2016February 4, 2016 by PharmaTimes

While news of the resurgent viral epidemic filtered in, Health Officials and government people alike have been caught in frenzy once again since the end of the battle with Ebola. Health Editor, MORGAN NWANGUMA who has been keeping a steady tab on the unfolding events, captures the details of these as well as what you need to know about the renewed Lassa fever epidemic which has become like a recurring decimal.

Ever since August of 2015 when the dreaded disease – Lassa fever made its latest come back into the country, the health authorities have continued to grapple with this renewed scourge. The major vector of this disease is a species of the popular house mouse, but not every rodent is necessarily a carrier of the disease, however, they are all potential hosts and transmitters of the virus.

History of Lassa fever

Lassa fever was first discovered in a village called Lassa in Bornu State in the year 1969 when two missionary nurses died in the country from the infection. Subsequently there had been intermittent outbreaks of the disease several times from then with different levels of severity across the West African sub region. The disease which is largely endemic in this region has also claimed since then some 5,000 victims within this region. Countries that are usually prone to the outbreak include Sierra Leone, Liberia, Guinea and Nigeria.

However, it is also important to note that other neighbouring countries are equally at risk in that the animal vector for Lassa virus, the Natal multimammate rat is widely seen throughout West Africa.

Lassa fever – signs and symptoms

Lassa fever is a member of the group of Viral Haemorrhagic Fevers (VHFs); it belongs to the virus family Arenaviridae, it is a single-stranded RNA virus and is zoonotic, or animal-borne.

VHFs are usually caused by four families of viruses such as – the Ebola, Marburg, Lassa and Yellow fever viruses. Some of the many common features of VHFs include the fact that they affect many body organs, inflict damage on the blood vessels; they also affect the body’s ability to regulate itself. Thus after about an incubation period of between 6 and 21 days an acute illness involving a multiple set of organs erupts; organs such as the kidney, liver, and the spleen are usually affected in the process.

The victims are affected when exposed to contaminants through the respiratory or gastrointestinal tracts, while the infection can also be transferred from person to person through direct contact with an infected person and so healthcare workers are advised to be extremely cautious while handling infected persons, etc. Some non-specific symptoms may include persistent high fever, low blood pressure, swelling of the face, muscle fatigue, conjunctivitis and mucosal bleeding. Other notable signs are such as – bleeding through the anus, nose and, or mouth; breathing difficulty, vomiting, sore throat, chest pain as well as back and abdominal pain may also be noticed.

Experts say as at the moment there is no available human vaccine for the disease, and that the only available drug for treatment – ribavirin must be administered within the first 6 days after the onset of the disease for effective remedy. Lassa fever is a haemorrhagic illness and it is transmitted to humans through contacts with food or household items that are contaminated by the excreta or urine of rodents. This disease is known to affect an average of between 300,000 and 500,000 people with about 500 deaths recorded annually in the West African sub region.

The return of Lassa fever

Sometime in the month of August, 2015 news filtered in that the dreaded contagious disease was back with us in the country; official reports confirmed that then some 270 cases of lassa fever were diagnosed in 12 states. Among the first set of victims include a nursing mother and her two weeks old infant; this occurred between Wednesday, December 30, 2015, and January 1, of this year in Rivers State while over 60 people were quickly put under surveillance as a result of the recent outbreak of Lassa fever. Fresh into the New Year the count of infections and victims have continued to increase almost on a daily basis with states like Taraba, Nassarawa and Rivers leading the pack.

Going back to recent history, authoritative sources have it that the last time the dreaded disease hit the country was back in 2014. Sources at the Nigeria Centre for Disease Control (NCDC) reminds us that the disease broke out in 10 states of the federation, in March 2014; the last epidemic resulted in the death of 20 people, out of the 319 cases that were reported. The states that were affected then included Anambra, Bauchi, Ebonyi, Edo, Gombe, Imo, Nasarawa, Ondo, Plateau and Taraba.

Further on the case in Rivers State, a medical doctor, Living Jamala, working with the Rivers State-owned Braithwaite Memorial Specialist Hospital later died from the infection just at the time the Federal Government was starting to process a trial vaccine. Dr. Jamala died in the early hours of Thursday 14 January after being kept in an isolated ward at the hospital.

Meanwhile the first case of Lassa fever was recorded in Lagos on the 15th of February, 2016 at the Ahmadiyya Hospital, Ojokoro – Lagos, where the patient (an undergraduate of Ahmadu Bello University, Zaria) was first diagnosed and treated for the disease and later transferred to the Lagos University Teaching Hospital (LUTH). Subsequently, the said hospital was sealed off and at the instance of this, 15 patients and 25 hospital staff were quickly placed under surveillance while 109 other people were on follow-ups.

According to the Federal Ministry of Health, so far the highly infectious disease has been reported in 64 local governments of seventeen states of the federation and Abuja. The hotspots among these health officials say are – Niger, Bauchi, Taraba, Kano, Edo, Nasarawa, Plateau and Rivers. As at press time, over 65 deaths have been recorded from about 283 cases reported nationwide.

Experts say though mortality rate is not usually that high – about 1 percent, but in times of epidemics Lassa fever outbreak can present a high death rate say up to 50 percent. Meanwhile the different governments of the various states affected have been dispatching health workers to sensitise the general public on the disease while forging collaboration with the World Health Organisation (WHO) on how to further combat and contain it.

The federal government has gone ahead since the outbreak to also order an immediate release of adequate quantities of ribavirin, the specific antiviral drug that is available for the treatment of Lassa fever to all the affected states. The product according to the Health Minister, Professor Isaac Adewole, will go a long way to effect prompt and adequate treatment of cases, and check the spread. Health watchers had also lamented the rate of spread, sighting inadequate funding for the continued spread of the disease and the fatality levels.

Explaining further the Minister said “… Nigeria has the capability to diagnose Lassa fever and all the cases reported so far were confirmed by our laboratories”. He pointed out also that he had directed that all health facilities in the country emphasise routine infection prevention and control measures while ensuring that all patients are treated free of charge. “No travel restrictions will be imposed from and to areas currently affected.

Healthcare workers seeing a patient suspected to have Lassa Fever should immediately contact the epidemiologist in the State Ministry of Health or call the Federal Ministry of Health using the following numbers: 08093810105, 08163215251, 08031571667 and 08135050005”, the Minister added.

How you can protect yourself

You will do well to ensure that rats or rodents are kept out of your rooms, out of the reach of your foods, drinks and every household item. In the words of a health expert who is also the Rivers State Commissioner for Health, Dr. Theophilus Odagme, “The public is advised to improve on the sanitation of their environment and home to prevent contact of rats with food stuffs.” Although not every rat or rodent is infected but you must keep a safe distance from them at such times as this because they are the main vectors of this disease.

Sometimes it is common place to find bits of rat excreta in your grains for instance without your being able to spot them. For this reason experts advice you make sure these foods are properly cooked before eating just to be on the safe side. Furthermore, you could as well store your grains in rodent-proof containers.

Other preventive measures will include: ensuring you maintain a good personal hygiene including also regular washing of hands with soap and water; properly dispose of your refuse – far away from your living apartment. All suspected patients of Lassa fever should be given immediate medical attention and isolated from the rest of the people while their excrements (urine and faeces) are carefully and properly disposed of. If death occurs, the body must not be handled but left to the health authorities to handle and bury hence the high level of health risk posed by it.

Also, members of the public are advised to remain vigilant, and promptly report any suspected cases to the health authorities or medical centres nearest to them. This is so very important because experts have warned that if serious attention is not paid to the spread of the virus, Nigeria stands the risk of recording up to 3,000 cases leading to a possible 1,000 deaths.